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Using CT to evaluate mediastinal great vein invasion by thymic epithelial tumors: measurement of the interface between the tumor and neighboring structures

Abstract

Objectives

For thymic epithelial tumors, simple contact with adjacent structures does not necessarily mean invasion. The purpose of our study was to develop a simple noninvasive technique for evaluating organ invasion using routine pretreatment computed tomography (CT).

Methods

This retrospective study analyzed the pathological reports on 95 mediastinal resections performed between January 2003 and June 2020. Using CT images, the length of the interface between the primary tumor and neighboring structures (arch distance; Adist) and maximum tumor diameter (Dmax) was measured, after which Adist/Dmax (A/D) ratios were calculated. Receiver operating characteristic (ROC) curves were used to analyze the Adist and A/D ratios.

Results

An Adist cut-off of 37.5 mm best distinguished between invaded and non-invaded mediastinal great veins based on ROC curves. When Adist > 37.5 mm was used for diagnosis of invasion of the brachiocephalic vein (BCV) or superior vena cava (SVC), the sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and area under the ROC curve for diagnosis of invasion were 61.9%, 92.5%, 81.25%, 82.2%, 81.97%, and 0.76429, respectively. Moreover, there were significant differences between BCV/SVC Adist > 37.5 mm and ≤ 37.5 mm for 10-year relapse-free survival and 10-year overall survival (p < 0.01).

Conclusions

When diagnosing invasion of the mediastinal great veins based on Adist > 37.5 mm, we achieved a higher performance level than the conventional criteria such as irregular interface with an absence of the fat layer. Measurement of Adist is a simple noninvasive technique for evaluating invasion using CT.

Key Points

Simple contact between the primary tumor and adjacent structures on CT does not indicate direct invasion.

Using CT images, the length of the interface between the primary tumor and neighboring structures (arch distance; Adist) is a simple noninvasive technique for evaluating invasion.

Adist > 37.5 mm can be a supportive tool to identify invaded mediastinal great veins and surgical indications for T3 and T4 invasion by thymic epithelial tumors.

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Abbreviations

A/D ratio:

The Adist-to-Dmax ratio

Adist:

Length of the interface between the primary tumor and neighboring structures

AUC:

The areas under the ROC curves

BCV:

Brachiocephalic vein

Dmax:

Maximum tumor diameter

ECG:

Electrocardiogram

FDG-PET:

[18F] Fluoro-2-deoxy-D-glucose-positron emission tomography

IASLC:

International Association for the Study of Lung Cancer

ITMIG:

International Thymic Malignancies Interest Group

NCCN:

National Comprehensive Cancer Network

NPV:

Negative predictive value

OS:

Overall survival

PPV:

Positive predictive value

RFS:

Relapse-free survival

ROC curves:

Receiver operating characteristic curves

SUV:

The standardized uptake value

SVC:

Superior vena cava

UICC:

Union for International Cancer Control

VATS:

Video-assisted thoracic surgery

WHO:

World Health Organization

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Acknowledgements

The authors are grateful to Profs. Hiroshi Nanjo (Department of pathology, Akita University Graduate School of Medicine) and Akiteru Goto (Department of Cellular and Organ Pathology, Akita University Graduate School of Medicine) for suggesting pathological diagnoses.

Funding

The authors state that this work has not received any funding.

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Correspondence to Kazuhiro Imai.

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The scientific guarantor of this publication is Yoshihiro Minamiya.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

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• retrospective

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• performed at one institution

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Cite this article

Kuriyama, S., Imai, K., Ishiyama, K. et al. Using CT to evaluate mediastinal great vein invasion by thymic epithelial tumors: measurement of the interface between the tumor and neighboring structures. Eur Radiol 32, 1891–1901 (2022). https://doi.org/10.1007/s00330-021-08276-z

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Keywords

  • Mediastinal neoplasms
  • Thymic epithelial tumor
  • Neoplasm invasiveness
  • Vena cava, superior
  • Brachiocephalic veins